Some high FBG numbers, first phase insulin response on way out? Advice, please!

[hose1975]

I had GD and was on insulin for both of my pregnancies; diet didn't cut it at all. Was told that it was a case of when, not if I went on to develop diabetes even with good eating, exercising and keeping my weight down. I am currently 8st 3, 5' 1" and walk or run (sometimes both) a minimum of two and a half miles per day as scheduled exercise.

I do a fingerprick FBG test every month just to monitor things, although I'm aware that it isn't the greatest gauge of blood sugar control and that I probably ought to do full-day testing every once in a while too. Usually the results are around the 5.4mmol/l range, but over the last three mornings the readings were 6.9, 7.1, 5.9 (hands were clean and I did the second and third reading because of the elevated first one). Out of interest I decided to test immediately prior to, and 30 mins, 1 hour 1.5 hours and 2 hours after breakfast (porridge, 35g carbs). Got a bit of a shock: the readings from yesterday morning were pre 6.5, 30 mins 9.5, 1 hour 6.7, 1.5 hours 5.5, 2 hours 5.9. This morning was similar: pre 5.6, 30 mins 10.2, 1 hour 6.7, 1.5 hours 5.8, 2 hours 6.0.

At the very least it looks as though my first phase insulin response is on the way out, at least from what I've read in various studies. If I did a normal GTT or just tested two hours afterwards I'd look normal, right? I'm also a bit concerned about the fasting readings. Should I be worried?

I'm at greater risk of both LADA and Type 2 because of a preexisting autoimmune thyroid problem and a family history of Type 2.

The question is what to do now: should I go to see the diabetic specialist GP at my practice about my concerns, or will he just give me the bum's rush out of his office because I'm not ill enough yet? Is it worth pushing for a referral to an Endo? Should I continue to test after breakfast (not the same results after other meals as there is significantly more fat and protein in those meals, and I'm not up for debating whether I should be eating porridge in the first place, thank you) and see if I get the same results for a week?

I also have periodic bouts of almost unquenchable thirst (4-5 litres of fluid per day, mostly settles down a bit by the end of the afternoon but the mornings are awful) but it's not all the time, which I find a bit odd! I'm fairly sure it's not the lithium that I'm taking and I've reduced my salt intake a bit too so it's definitely not that. Is it possible to have transient diabetes-related polydipsia in the early days of break-down?

I'm currently battling a flare-up of Hashimoto's and that's making me feel a bit ****** and tired, but I'm eating well (keeping my carbohydrates to 50% of my daily calorie intake or less, equates to roughly 150g per day) and still exercising.

All advice most gratefully received; I'm a bit worried that diabetes will hit before 40

Thanks

Jo

 

[gfmoore]

I do a fingerprick FBG test every month just to monitor things, although I'm aware that it isn't the greatest gauge of blood sugar control and that I probably ought to do full-day testing every once in a while too.

Usually the results are around the 5.4mmol/l range, but over the last three mornings the readings were 6.9, 7.1, 5.9 (hands were clean and I did the second and third reading because of the elevated first one).

Out of interest I decided to test immediately prior to, and 30 mins, 1 hour 1.5 hours and 2 hours after breakfast (porridge, 35g carbs). Got a bit of a shock: the readings from

yesterday morning were pre 6.5, 30 mins 9.5, 1 hour 6.7, 1.5 hours 5.5, 2 hours 5.9.
This morning was similar: pre 5.6, 30 mins 10.2, 1 hour 6.7, 1.5 hours 5.8, 2 hours 6.0.

At the very least it looks as though my first phase insulin response is on the way out ...

I also have periodic bouts of almost unquenchable thirst (4-5 litres of fluid per day,..

Jo

Hi Jo, sorry edited your post so I could see your figures more clearly.

Right, the figures you've quoted look pretty good to me. I would only have any real concern if my 1 hour level went above about 7 or 8 and even then if it came don I'd be okay with it. Your's look pretty good and since they then come down back to about normal (for you) two hours later then I'd say (but I'm not a doctor) that your body is still working quite well.

It would be nice if your basal level (the main pre food level) was perhaps lower - but we all have different targets to aim for - mine is in the 4s and I'm in the high 5s at the moment.

BUT a level of 5 or 6 is unlikely to be damaging your bod - see www.bloodsugar101.com

I think I agree with your own analysis that you should test more than once a month, at least until you gain confidence in your own control and slf knowledge. What you are doing with the pre, 1 hour and two hour is great and continue with that. perhaps have a day where you go mad and test every hour, even during the night and see what your numbers do during the day. When I did this it really awakened my understanding, however, each to his or her won. If you can link your meter to the pc and graph your readings so much the better.

BUT the thirst thing is a little more concerning - hopefully someone will be along with a bit more insight into this. Maybe you might just contact your surgery and ask for an opinion as to whether you should go in for a chat. Like everything else with diabetes we don't want to leave things too long when we don't understand them

I'm sure you'll get to the bottom of this with no worries - all the best.

 

[hose1975]

As I understand it, blood sugars peak after 30 minutes or so and the first-phase insulin response should take care of it; the fact that my 30 min numbers are higher than 7.8 or so (a number that normal people, with everything working as it should, never or very very rarely go over according to the studies done) is the thing that concerns me as it is my understanding that first-phase insulin response is the first thing to go in LADA and Type 2 diabetes.

So although my numbers at the 1 and 2 hour marks look just peachy, the 30-minute reading looks too high for the normal insulin response to have happened. Or have I misunderstood how the first-phase insulin response works?

 

[jack412]

Not perfect, but nothing to be concerned too much about
You may have a bit of sickness coming. See what it is next week
Aren't you under an endo with your thyroid, he can do your pré diabetes too

 

[gfmoore]

http://www.phlaunt.com/diabetes/16422495.php

May put your mind at rest. Honest.

How's the thirst thing?

 

[hose1975]

The thirst thing has receded some for the time being. But I'm still puzzled by the high 30-minute readings. The website you linked to (one I know well) suggests that blood sugar at any point after ingestion of carbohydrate should not go over 7.8; this is how it goes with in the non-diabetic community. So the question still stands: given that I'm starting to see readings of 10+ at 30 minutes, and that first phase insulin release is responsible for locking down the inevitable peak in blood sugar following the ingestion of carbohydrates, which should keep them under 7.8 at 30 minutes, is this a possible indication that my first phase insulin response may be on the way out?

 

[phoenix]

It isn't that rare to go above 7.8mmol/l
Other later studies using a greater variety of subjects and longer periods using a cgm have shown that most people spend sometime during the day at over 7.8mmol/l . Spending an average (median ) 31 min a day above this (range 0–412 min).
If you read the discussion section of this paper you will see that it also references other studies including one 28 day CGM study found that 7/32 of their subjects with confirmed normal glucose tolerance reached levels of over 11.1mml/l . (and even in the early one cited earlier, the brown lines which show the variation (2sd) demonstrate that some of these young people reached levels of 160mg/dl (8.8mmol/l)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892065/?report=reader#!po=45.0000
The conclusion is worth reading too as it suggests that we don't actually know if there are any adverse consequences of these periods of higher glucose levels which seem to occur in people who at present have normal glucose tolerance ( perhaps because it was assumed that these periods didn't happen)

As you know, you are at risk so it's probably a good idea to discuss your concerns with your doctor?